Chapter 36.5, Problem 1CT

Since the 1950s, when living kidney donation was first recognized as a viable alternative to cadaver organ donors, family and friends have come forward to offer a kidney to a victim of kidney failure. To reduce the chance that the recipient’s immune system will attack the donated kidney as if it were an invading microbe or parasite, the donor’s blood type and several important glycoproteins should match those of the recipient. But, with the exception of identical twins, no two people have perfectly matching tissues. This means that most people with kidney transplants must take immune-suppressing drugs for the remainder of their lives, making them vulnerable to infections and some types of cancer. Despite this drawback, a transplanted kidney is by far the best option for those lucky enough to receive one.

  To remove a donor kidney (FIG. 36-9), surgeons generally use a technique called laparoscopic surgery, where they make half-inch incisions through which they insert surgical tools, including a tiny video camera to guide the operation. The kidney is extracted through an incision about 2½ inches long, put on ice, and rushed to its recipient. The operation takes 3 to 4 hours; donors remain in the hospital for about 3 days and return to work in about 3 weeks. In addition to the risks associated with major surgery, kidney donors will lack a backup kidney in the unlikely event that their remaining kidney fails. But a recent study of deaths among 80,000 kidney donors during a 15-year period found no greater mortality among this group (once they had recovered from their surgery) than among non-donors.

FIGURE 36-9 Surgeons transplant a kidney

  Domino donations are almost always started spontaneously by someone inspired to make a difference. Since 2008, when DeGiulio’s donated kidney started a chain that saved four lives (FIG. 36-10), such domino donation chains have become longer and more frequent. For example, during a 4-month period, 17 hospitals in 11 states from California to New Jersey matched 30 people—who might otherwise have died—with kidneys from 30 donors they had never met. This heroic enterprise was started by Good Samaritan Rick Ruzzamenti, who got the idea from the desk clerk at his yoga studio, who had mentioned to him that she had donated a kidney to a friend. “People think it’s so odd that I’m donating a kidney,” he told the transplant coordinator at his hospital, but “I think it’s so odd that they think it’s so odd. . . . It causes a shift in the world.”

FIGURE 36-10 Domino donations Kidneys from compatible strangers saved the lives of these four recipients.

  The more than 100,000 eligible individuals awaiting a kidney transplant ardently hope that domino donation chains continue to be forged and to lengthen.

CONSIDER THIS Would you donate a kidney to a friend or family member whose kidneys were failing? Would you consider donating a kidney to a stranger? Explain your reasoning.